What makes health services usable?: Insights from a qualitative study of caregivers of children with disabilities.

Background: The concept of usability from the field of user-centered design addresses the extent to which a system is easy to use, including under extreme conditions. Apart from applications to technologies, however, little attention has been given to understanding what shapes usability of health services more generally. Health service usability may impact the extent to which patients avail themselves of and benefit from those services.

Why Do Some Caregivers of Children with Disabilities Participate in Care Management While Others Do Not? Lessons from a Population in a Pediatric Accountable Care Organization.

Accountable care organizations (ACOs) offer care coordination services in an attempt to lower costs while improving the quality of care; however, not all families participate. We conducted focus groups and individual interviews with caregivers of children who recently joined a pediatric ACO and evaluated why some caregivers of children with disabilities engage in care coordination while others do not. Four common themes emerged as factors influencing the degree of caregiver engagement in care coordination services.

Can Payment Reform Be Social Reform? The Lure and Liabilities of the "Triple Aim".

The formulation of the triple aim responds to three problems facing the US health care system: high cost, low quality, and poor health status. The purpose of this article is to analyze the potential of the health care system to achieve the triple aim and, specifically, the attempt to improve population health by rewarding providers who contain costs. The first section of the article will consider the task of improving population health through the health care system.

What Is the Value of Value-Based Purchasing?

Value-based purchasing (VBP) is a widely favored strategy for improving the US health care system. The meaning of value that predominates in VBP schemes is (1) conformance to selected process and/or outcome metrics, and sometimes (2) such conformance at the lowest possible cost. In other words, VBP schemes choose some number of "quality indicators" and financially incent providers to meet them (and not others).

Teaching by (bad) example: what a confused attempt to "advance" EBM reveals about its underlying problems: commentary on Jenicek, M. (2015). Do we need another discipline in medicine? From epidemiology and evidence-based medicine to cognitive medicine and medical thinking. Journal of evaluation in clinical practice, 21:1028-1034.

Professor Jenicek's paper is confused in that his proposal to 'integrate' what he means by 'evidence-based scientific theory and cognitive approaches to medical thinking' actually embodies a contradiction. But, although confused, he succeeds in teaching us more about the EBM debate than those who seem keen to forge ahead without addressing the underlying epistemological problems that Jenicek brings to our attention. Fundamental questions about the relationship between evidence, knowledge and reason still require resolution if we are to see a genuine advance in this debate.

Instrumentality in health care: a response to Adam Oliver.

In his paper, 'Incentivizing improvements in health care delivery', Adam Oliver discusses recent efforts to manage the performance of health care workers in the United States and United Kingdom. Overall, the results of performance management seem to be mixed, but Oliver's discussion hints at a more fundamental question about this approach, specifically: what are the limits of a focused instrumentality in a context as rich, fluid and collaborative as the delivery of health care? Might performance management schemes actually frustrate the efforts of conscientious health care workers? Indicators make few allowances for the heterogeneity of treatment effects or patient values or preferences. Health care workers may also face pressure to appear to satisfy indicators that are actually impossible to satisfy.

Particularism in health care: challenging the authority of the aggregate.

In health care, particularism asserts the primacy of the individual case. Moral particularists, such as Jonsen and Toulmin, reject deduction from universal moral principles and instead seek warrants for action from the multiple sources unique to a given patient. Another kind of health care particularism, here referred to as the knowledge of particulars, is offered as a corrective to evidence-based medicine (EBM), its influence on health care practice and policy, and specifically to EBM's reliance on the aggregate.

Advocating self-advocacy: board membership in a statewide mental health consumer organization.

Until 2008 Ohio Advocates for Mental Health was a statewide mental health advocacy organization run by mental health consumers and supportive of consumer-run organizations around the state. The author's tenure on the board entailed repeated engagement with questions of identity - self-identity, peer support through personal identification, and negotiation of public identities with provider groups and the state agency. These are fundamental to defining and legitimating the claims of mentally ill people not just for health care resources but for full participation as citizens in the public sphere.

What is Patient-Centered Care? A Typology of Models and Missions.

Recently adopted health care practices and policies describe themselves as "patient-centered care." The meaning of the term, however, remains contested and obscure. This paper offers a typology of "patient-centered care" models that aims to contribute to greater clarity about, continuing discussion of, and further advances in patient-centered care.

Reducing variation in health care: the rhetorical politics of a policy idea.

For decades, geographic variation in the use and cost of health care has captured the imagination of researchers and policy makers. As a policy problem, variation suggests its own solution--reducing variation--but the substantive weaknesses of this policy idea invite a second look at its success. This article considers the politics of policy ideas to analyze the potential rhetorical strengths of reducing variation.

Improving the quality of medical care: the normativity of evidence-based performance standards.

Poor quality medical care is sometimes attributed to physicians' unwillingness to act on evidence about what works best. Evidence-based performance standards (EBPSs) are one response to this problem, and they are increasingly employed by health care regulators and payers. Evidence in this instance is judged according to the precepts of evidence-based medicine (EBM); it is probabilistic, and the randomized controlled trial (RCT) is the gold standard.

Consumer-operated service organizations: organizational characteristics, community relationships, and the potential for citizenship.

Consumer-operated service organizations (COSOs) are independent organizations whose administrative and financial control resides with consumers. Based on a 2008 mail survey and followup interviews conducted in 2009, this study depicts the internal characteristics and external relationships, as well as some relationships between the two, of COSOs in one state. Profiles include on the one hand, governance structures, services provided, sources and levels of funding, etc.

Characteristics associated with organizational independence in consumer-operated service organizations.

Objective: This research compares two types of consumer organizations in one state in order to explore the significance of organizational independence for internal structure/operations and external relationships. The first type, consumeroperated service organizations (COSOs), are independent and fully self-governing; the second are peer-support service organizations (PSSOs), which are part of larger non-consumer entities.

Methods: Mail surveys were completed by COSO and PSSO directors of a geographically representative sample of organizations; telephone interviews were conducted with a sub-sample.

Mental health consumer-operated services organizations in the US: citizenship as a core function and strategy for growth.

Consumer-operated services organizations (COSOs) are independent, non-profit organizations that provide peer support and other non-clinical services to seriously mentally ill people. Mental health consumers provide many of these services and make up at least a majority of the organization's leadership. Although the dominant conception of the COSO is as an adjunct to clinical care in the public mental health system, this paper reconcieves the organization as a civic association and thereby a locus of citizenship.

Comparative effectiveness research: evidence-based medicine meets health care reform in the USA.

Rationale Comparative effectiveness research (CER) is the study of two or more approaches to a health problem to determine which one results in better health outcomes. It is viewed by some in the USA as a promising strategy for health care reform. Aims and Objectives In this paper, nascent US CER policy will be described and analysed in order to determine its similarities and differences with EBM and its chances of success.

Who treats limited English proficient patients? Implications for linguistic access initiatives.

Background: Growing linguistic diversity in the United States brings serious challenges for healthcare providers. Federal civil rights policy requires that physicians participating in Medicaid and State Children's Health Insurance Program (SCHIP) provide meaningful access for their limited English proficient (LEP) patients. Key to compliance is the criterion that the provider's responsibility is proportional to the number of LEP patients likely to be served.

Pay for performance in Medicare: evidentiary irony and the politics of value.

Pay for performance (P4P) is of growing importance in the Medicare program. Pay-for-performance policy has the support of political actors in both parties and in the legislative and executive branches; of experts, business, and consumer interests; and in a qualified way, of health care providers. The evidence that P4P improves quality or reduces cost, however, is scant, although P4P proponents claim that the program is evidence based.

Perspectives on evidence-based practice from consumers in the US public mental health system.

Rationale, Aims And Objectives: Evidence-based practice (EBP) is a matter of mental health policy in USA. Supporters find it useful in two forms, as generating a list of approved practices and as providing information to practitioners and consumers engaged in shared decision making. Almost nothing has been written about consumer perspectives on EBP.

Consumer perspectives on information and other inputs to decision-making: implications for evidence-based practice.

This study is an exploration of mental health consumers' perspectives on information, including scientific information, and on other inputs to decision-making. Four focus groups were held with severely mentally ill consumers at two sites in the summer of 2005. Consumers varied in age, race and diagnosis.

The role of "evidence" in recovery from mental illness.

Evidence-based practice (EBP), a derivative of evidence-based medicine (EBM), is ascendant in the United States' mental health system; the findings of randomized controlled trials and other experimental research are widely considered authoritative in mental health practice and policy. The concept of recovery from mental illness is similarly pervasive in mental health programming and advocacy, and it emphasizes consumer expertise and self-determination. What is the relationship between these two powerful and potentially incompatible forces for mental health reform? This paper identifies four attempts, in the mental health literature, to delineate the role of "evidence" in recovery.

Evidence-based practice as mental health policy: three controversies and a caveat.

Evidence-based practice (EBP) is the subject of vigorous controversy in the field of mental health. In this paper I discuss three distinct but interrelated controversies: how inclusive the mental health evidence base should be; whether mental health practice is a variety of applied science; and when and how the effectiveness goal in mental health is defined. I provide examples of evidence-based policy in mental health.